Provider Demographics
NPI:1740309251
Name:LEHMAN'S PHARMACY, LLC
Entity type:Organization
Organization Name:LEHMAN'S PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-253-4746
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-1490
Mailing Address - Country:US
Mailing Address - Phone:217-253-4746
Mailing Address - Fax:217-253-3238
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-1490
Practice Address - Country:US
Practice Address - Phone:217-253-4746
Practice Address - Fax:217-253-3238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHMAN'S PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054007317333600000X
IL054016763333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1448186OtherOTHER ID NUMBER
IL371093843001Medicaid
1448186OtherNCPDP
1448186OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IL371093843001Medicaid
0740340001Medicare NSC